Compression vital in management of venous leg ulcers

The most common leg and foot ulcers that present to dermatologists are venous ulcers, and compression is key to effective management of these ulcers, according to O. Fred Miller III, M.D., F.A.A.D., emeritus director of dermatology at Geisinger Health System in Danville, Penn.

“It is important to know the etiology of the ulcer,” Dr. Miller says. He spoke at a course on wound healing at the 73^rd annual meeting of the American Academy of Dermatology (San Francisco, 2015). “You need to know if it’s venous or arterial. You always want to know if the patient is diabetic and neuropathic,” he says.

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The most basic tenet of wound healing is ensuring adequate blood perfusion, so ischemic ulcers need to be revascularized so that there is adequate perfusion, Dr. Miller says.

It’s necessary to eliminate edema, pressure and friction, as well as necrotic and infected tissue to achieve re-epithelialization, and Dr. Miller cautions that the healing process is fragile.

“If you constantly change dressings or traumatize the wounds, you will destroy the re-epithelialization,” Dr. Miller says. “The treatment for wounds is moist wound care.”

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A myth that has been debunked is that wounds should be exposed to the air and allowed to dry, Dr. Miller says. “That is absolutely incorrect,” Dr. Miller says, suggesting Vaseline can be applied to maintain moisture and achieve epithelialization.

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